Gynae - vulva, vagina, uterus Flashcards
Infections of genitalia - 7 types of bacteria
- Herpes virus
- Molluscum contagiosum
- HPV
- Chlamydia trachomatis
- Neisseria gonorrhoeae
- Candida
- Trichomonas
pelvic inflammatory disease (PID) clinical symptoms (4)
- pelvic pain
- adnexal tenderness (abnormal growth near the uterus)
- fever
- vaginal discharge
diseases affecting vulva (3 types)
- bartholin cyst
- non-neoplastic epithelial disorders
Lichen simplex chronicus, Lichen sclerosus - neoplasms
(benign) hidradenoma, condylomas
(malignant) VIN, SCC, Paget’s (vulva)
vulva paget’s disease
- type of tumour
- micro appearance
- clinical appearance
- prognosis
- in-situ adenocarcinoma
- atypical large cells
confined to lining epithelium (basement membrane)
arises from primitive ducts and spreads along lining epithelium - redness, exise area w/ margins
- good prognosis
intraepithelial tumours (3)
- VIN (Vulvar intraepithelial neoplasia)
- VAIN (Vaginal Intraepithelial Neoplasia)
- CIN (Cervical Intraepithelial Neoplasia)
diseases affecting vagina
- Congenital anomalies
- VAIN
- Adenocarcinoma - caused by mother taking DES drug during pregnancy
- Embryonal rhabdomyosarcoma = sarcoma botryoides
clear cell adenocarcinoma (CCA) of vagina
- affects who
- discoverable at what age
- micro appearance
- precursor
- young women w/ mothers treated w/ DES drug during pregnancy
- 15-20yrs
- Vacuolated tumor cells in clusters and gland-like structures
- precursor: vaginal adenosis = presence of glandular epithelium in vagina
Embryonal rhabdomyosarcoma = sarcoma botryoides
- what type of tumour
- affects who
- treatment
botryoides = grape-like branches
rhabdomyosarcoma = tumour in soft tissue
- affects infants/children
- surgery + chemotherapy
cervical intraepithelial neoplasia (CIN)
- types
- where does it affect most commonly
- CIN I/ II/ III
(CIN I is the lowest grade w/
mild dysplasia; CIN III - severe dysplasia/carcinoma in situ) - usually happens in the transformation zone (btw ectocervix and endocervix)
simple columnar -> stratified squamous
CIN risk factors
- Early age at first intercourse
- Multiple sexual partners/ partner has multiple sexual partners
- Increased parity (give birth many times)
- cancer-associated HPV**
- Certain HLA and viral subtypes
- Exposure to oral contraceptives and nicotine
- Genital infections (chlamydia)
cervical cancer screening
- age group
- frequency
25-69 yrs
every 3 years
HPV micro features
- multinucleation
- perinuclear halo
- crinkled nuclei
cervical neoplasia -> cervical cancer pathogenesis (3 steps)
- HPV infection
HPV disable protective functions of p53 and R8 -> unchecked cell proliferation** - progression (1 year)
- invasion
cervical carcinoma gross appearance (3)
- fungating
- ulcerating
- infiltrative
types of cervical carcinomas
- Squamous cell carcinoma** (forms majority of cervical cancers)
- Adenocarcinoma
- Adenosquamous
- Undifferentiated
3 types of squamous cell carcinomas
- large cell non-keratinising
- large cell keratinisng
- small cell (SCC)
spread of cervical cancer
- local invasion: (related structures) uterus, vagina, bladder, rectum
- lymphatics
- hematogenous (bloodstream): lung, liver, bone, brain
staging of carcinoma cervix
- what is it based on
based on local invasion
1: only cervix
2: upper vagina/ parametrium
3: pelvic wall/ lower vagina
4: rectum
diseases affecting uterine corpus
- Endometrium – normal, polyps, hyperplasia, carcinoma, stromal neoplasms
- Myometrium - leiomyomas, leiomyosarcoma, adenomyosis
- Mixed mullerian tumour (carcinosarcoma)
diseases affecting endometrium of uterine corpus (lining of the uterus)
- polyps
- hyperplasia (cystic/ complex)
- carcinoma
- stromal neoplasm
diseases affecting myometrium of uterine corpus
- leiomyomas (SM tumour)
- leiomyosarcoma
- adenomyosis - inner lining of the uterus (endometrium) breaks through the muscle wall of the uterus (myometrium)
endometrial hyperplasia
- cause
- effect
- 2 types
caused by unopposed estrogen stimulation + mutation of PTEN tumour suppressor gene
causes abnormal vaginal bleeding
- typical vs atypical hyperplasia
(atypical has higher risk of progressing to endometrial carcinoma)
cystic hyperplasia micro appearance
Irregularly dilated glands
looks like proliferative glands
complex hyperplasia micro appearance
+ complication
Glandular crowding and irregular shape
Loss of PTEN tumour suppressor gene -> High risk of cancer
endometrial carcinoma**
- affects which age group
postmenopausal women
causes of endometrial carcinoma (2)
+ risk factors**
- prolonged estrogen stimulation (type 1)
- p53 gene mutation (type 2)
risk factors: late menopause/early menarche.
obesity
3 ways that prolong estrogen stimulation
- Endometrial hyperplasia
- Ovarian estrogen secreting tumours
- ERT (enzyme replacement therapy)
tumour caused by p53 gene mutation
- prognosis
- differentiation
(No preexisting hyperplasia)
- Poor prognosis
- Poorly differentiated serous type
progress of tumour formed by prolong estrogen stimulation (type 1)
+ grading and prognosis
proliferative endometrium -> non-typical hyperplasia -> typical hyperplasia -> grade 1 uterine endometrial carcinoma better prognosis than type 2
staging of uterine endometrial carcinoma
- stages
- invasion of what structures
4 stages
1: Corpus only (affects majority)
2: Corpus & cervix
3: Invasion into pelvis
4: Outside pelvis
leiomyoma of uterus
- affects who
- progression
- complications
Most common uterine neoplasm
>30 yrs, regresses after menopause
- Increase in size with nuclear estrogen receptor/ progestins (hormones affecting progesterone receptor) and pregnancy
- presents w/ multiple tumours
stimulations of hormone receptors can cause increase in size + hemorrhagic degeneration
leiomyoma of uterus
- which parts does it affect (4)
- pedunculated (outside myometrium - uterine cavity/ outside uterus)
- subserosal
- intramural
- submucosal
clinical symptoms (3) + complications (2) of leiomyoma
(ABS - IS)
- Abnormal bleeding (heavy menses)
- Bladder compression
- Sudden pain
- infertility
- spontaneous abortion
leiomyoma **
- gross appearance
- histo features
red degeneration:
- beefy red appearance due to rapid growth and infarction with subsequent haemorrhagic degeneration
- well circumscribed, smooth round nodule in wall of uterus
histo:
- well circumscribed tumour w/ interlacing bundles of uniform spindled cells:
blunt ended nuclei and eosinophilic cytoplasm
leiomyosarcoma
- histo appearance
- complications
- Increased mitosis
- necrosis
- atypia
Metastasize to lungs/brain
low 5 year survival
endometriosis definition
Presence of endometrial glands and stroma in abnormal locations outside the uterus
endometriosis**
- location
- clinical symptoms
- complications
- mostly in abdominal cavity (undergoes cyclic bleeding even when it is not in the uterus)
- dysmenorrhea (pain during menstruation)
pelvic pain
infertility - may progress to endometrial/ clear cell carcinoma
adenomyosis**
- definition
- 2 types
- ectopic endometrial deposits in MYOMETRIUM
w/ overgrowth of muscle and connective tissue
- diffused (deposits confined within myometrium) - more common vs localised (looks like fibroid, w/ brown coci)
abnormal bleeding in prepuberty**
precocious puberty (early puberty <8yrs) hypothalamic/pituitary/ovarian problems
abnormal bleeding in adolescence**
anovulation (lack of menses)
coagulation disorders
abnormal bleeding in reproductive stage**
pregnancy complications (abortion, trophoblastic disease, ectopic pregnancy) leimyoma, adenomyosis, polyps, endometrial hyperplasia, endometrial carcinoma
abnormal bleeding in perimenopausal stage**
dysfunctional uterine bleeding
anovulation
carcinoma, hyperplasia, polyps
abnormal bleeding in postmenopausal stage**
endometrial atrophy
carcinoma**, hyperplasia, polyps
investigations to identify etiology of bleeding
- pelvic ultrasound
- hysteroscopy (if u/s found to have endometrial polyp)
- endometrial sampling
treatment of polyps
hysteroscopic polypectomy
treatment of adenomyosis
mirena (hormonal IUD - intrauterine device)
hysterectomy
treatment of leiomyoma
myomectomy
hysterectomy
treatment of malignancy
THBSO (Total Abdominal Hysterectomy and Bilateral Salpingo-Oophorectomy)
why does leiomyoma -> heavy menses?
tumour expands myometriumci - increase surface area of endometrial cavity (extra outpouching) -> increase shedding
CIN III histo features
- full thickness dysplasia of squamous mucosa
- loss of maturation
- cytologic atypia: cells have high n/c ratio, irregular nuclear membrane
squamous cell carcinoma of cervix
- histo features
- diagnostic test
- tumour invades into surrounding cervical stroma
- presence of keratin pearls
- intercellular bridges
cytokeratin stain positive
